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Monday, March 2, 2015

New Directions

I read with caution the following article discussing the possibility of mandating bilingual labels. http://drugtopics.modernmedicine.com/drug-topics/news/should-california-require-bilingual-drug-labels

My question is: Where does it stop?
When I worked near a university, we had professors from all over the world living in town and filling prescriptions with us.
I didn't know if English was a primary language.
I didn't know what was their primary language.
I didn't know if their families were born here and could speak English.
What about people whose primary means of communication is American Sign Language?

I believe we should have a Themed Label Day.
Since no one is expected to learn English anymore, we could take this opportunity to teach other languages to everyone via our labels.

We could have Braille day for the blind.
ASL day for the hearing impaired.
National Talk Like A Pirate Day, just because...
We could have a special Yoda Speak label.
I am a fan of the poetic verse labels.
Haiku labels would be fun too.

One tablet a day you shall take. With food it must be.

Inhale two sprays into left and right nare
So you're not allergic to all the fresh air.

Take one tab by mouth
Two times a day with meals
As needed for pain

Thursday, February 26, 2015

UpCharges and Pharmacy Phees

Pharmacies should look into modeling their services and fees on the airline industry. If ever there were an ideal model of how to run a barebones operation it's the airlines.
The following offers/price schedules would be the norm: 

1. Your first 2 prescriptions are free to process. Each additional prescription filled that day will incur an additional processing fee. 
2. Electronic prescriptions and faxes will be processed for free, following Rule #1, while handwritten hard copies presented at the counter will incur an additional fee. (Exemptions for controls that must be handwritten in states that haven't caught up and passed the requisite laws just yet.)
3. If your prescription must be dispensed in multiple bottles (i.e. 180 Metformin 1000mg) there will be an additional charge for the extra label, vial and cap.
4. Any changes made to your prescription once it has been finalised (billing changes, quantity changes, coupon cards, etc) will result in additional fees.
5. Prescriptions not picked up and returned to stock will be assessed a restocking fee.
6. Prescriptions that have been restocked that you now wish to purchase will be charged the original copay, the restocking fee, the new copay, plus an additional "convenience" charge.
7. You must have your photo ID ready at pick up on all prescriptions and the name on the ID must match the name sent by the prescriber and the name we have on file.
8. Counseling is mandatory and FREE at time of purchase only. Any questions asked once the register transaction is completed will be assessed additional fees based on type of question asked and duration of consultation.
9. Your prescriptions have the right to be "bumped" for higher priority patients (sick children, emergencies, etc) if our queue is full. You will be compensated by having the additional prescription fee waived on a future fill date.
10. You must check in at the ticket counter (drop off) before going to the gate (pick up) to ensure your flight (prescription) is ready and arriving on time. If not, please have a seat in the lounge (waiting area) where you will be called to board.  

Wednesday, February 25, 2015

If Real Life Were Like Phone Calls

We need a sign.
We need a signal. 
We need a visible form of communication; something people are already used to hearing. 
Customer Service Providers have this down to a science. 
If we truly wish to champion customer service in our industry, we could learn a few tricks from these professionals. 

How many times have you called a company only to hear the following message? :
"We are currently experiencing a higher call volume than expected. Our representatives are working with other customers at this time."

Can we get that here? If a tech calls off or it's the first of the month, we can post a sign that says: "We are currently experiencing a higher script total than expected. Wait times may be increased." 

Fire departments set maximum occupancies for businesses. Many places will only allow people to enter once people have begun to leave in order to remain at safe levels. I say we should be permitted to have maximums on the number of waiters permitted.
"I am sorry, we have reached capacity for the number of waiters we are allowed to process from 2-3pm. You are welcome to leave your prescriptions and return for them in the 3-4pm window or you can try your wait again later."

Monday, February 23, 2015

Please Feed the Pharmacy Staff

We work in a zoo.
Not a place like a zoo. 
A real zoo. 
I'm not talking about the chaos. 
I'm talking about our cage. 
We are behind a counter. We are behind a partial window or barrier where people can walk by and observe us. There are people who go to zoos simply to have lunch and watch the giraffes. Others prefer to run to the monkey exhibits first.
Same with pharmacy. There are those who come to get prescriptions filled and watch us while we work on their orders. There are others who come for the other exhibits in the store, but can't help walking past the pharmacy encounter and point and gawk at the lowly humans forced onto display for their amusement. 

As in the zoo where you may see some lettuce or bits of food scrap lying around, depending on the time of your visit, you are also likely to see the humans with orts scattered around the counters or in their pockets. I believe we should embrace the zoo-like habitat in which we are forced to dwell. Let's install little gum ball-like vending machines in front of our counters. Instead of pellets for the ducks, we could offer Cheetos and Orange Slices (non-projectile-like food is favoured). This way, when people get mad and want to throw something at us, it will not hurt, and be edible! We could post signs that read: "Please feed the humans!".

Patient interactions would now include more bartering.

Impatient Guest: How long is this going to take?
CP: 17-23 minutes should suffice.
IG: Why so long?
CP: I'm feeling a wee bit peckish. Hunger makes me sluggish and disoriented. Need more time to focus.
IG: You should eat.
CP: Not allowed. No breaks. I can only eat food that fits in my pockets.
IG: How can I help?
CP: See that little feeder out there? The one with the brownies?
IG: Yes…?
CP: Go put a dollar in there and feed us. May help to bring back my super powers and I can fight this mid-afternoon somnolence.
IG: And then?
CP: Your prescription will be ready in 16-21 minutes.
IG: That sounds better.

Friday, February 20, 2015

Schools of Pharmacy

We have too many.
We need to police ourselves.
Pretty soon, Community Colleges will become the Caribbean of Medical Schools. (Sure, some good prescribers have come from schools there.)

When a degree takes nearly a decade to achieve, opening schools now that take years to become accredited will only help us in 10 years. Unfortunately, by most calculations, the profession will be saturated, again, as it was in the early 90's.
We need to stop opening new schools of pharmacy.
Increase enrollment at the best schools to adjust for demand. Decrease enrollment as needed to adjust for demand. Opening new schools? Without a placement system? Without a guarantee of a need?
Senseless. Reactionary. Money-grabbing.

We need quality over quantity.
We don't need to become the lawyers of the healthcare profession where we are a dime a dozen.

What is another problem we can see with too many graduates? Loss of our identity. For some time I have quit using the term "doctors" to describe those medical professionals. Why? I don't want to give credit where it is not due. There are many groups now who can prescribe. Without knowing who is and who is not an actual doctor, I believe the generic terms "practitioner" or "prescriber"are more appropriate. There was a need for more people to take care of sick people in this country. We imported as many as we could but how else could we increase that number? Give more professionals the right to prescribe. It's like the Old Catholic way of thinking about how to increase your flock: If you can't birth them, convert them.

Soon, Pharmacists will have the right to prescribe as well. However limited or broad the scope of these rights, it does not diminish the fact that we can prescribe. What then? Doctors will have to find a new way to have their egos stroked. No longer can they monopolize the "I'm a Doctor!" mantra. Patients will recognize they can go anywhere to receive a prescription.
To them I will say "welcome to being marginalized!".

Unless we do something as a group, as a unified profession to stop the greedy reach of our professional education system, we will continue hurting our beloved profession.
We have too many pharmacists. We continue to train more than we need. New pharmacists need jobs and are cheaper to employ. Older, more experienced pharmacists are at risk of losing their jobs. Eventually, and not too far away, our profession becomes the "you want fries and a flu shot with that?" minimum wage job that Corporate America is longing for it to be.

If your state is considering opening a new pharmacy school, consider petitioning them to stop it. With the number of schools having nearly doubled over the last 25 years, and the number of graduates along with it, the number of available jobs has not kept pace.


We are killing our own profession and no one is going to stop us.

Thursday, February 19, 2015

The System

Skynet is real.
We continue to feed it information.
It's like "The Cloud".
Or "THE System"…You know "THE System", right? This is where everything in the world is located and conveniently stored so it can be plucked out of the void at a moment's notice to serve your every whim.
It's like THE Google, only more personal.
There is no arguing with someone once they invoke "THE System" argument.
It's like to trying to argue with a woman after she says "fine".

To Wit: (and yes, sometimes I continue these witty dialogues just to see how far down the rabbit hole I may be drawn.)

CP: Guten Morgen.
Frau I Can't Know Everything Now: Tag. Here is my insurance.
CP: There is no prescription information on here.
FICKEN: Just plug in the numbers.
CP: To what?
Herr FICKEN: "THE System".
CP: Oh. <wink, wink> Got it. "THE System. <pantomimes air-typing 100 wpm over the counter and blankly staring at the sky>
FICKEN: What are you doing?
CP: Shhh. I'm entering the information you provided into THE System.
FICKEN: How's that work?
CP: About as well as this useless card you just gave me. I would have had more luck if you had pulled your Diner's Club card out of your Members Only jacket from 1983 instead of this.
H-FICKEN: They said to just give you this card and tell you to put the information into "THE System".
CP: And you watched me do that and saw how successful it was. I hate to be the bearer of bad news, wait, no I don't, but there is no Skynet. There is no THE System <holds arms outstretched> anywhere for me to input and pull data using these numbers. Call your HR Dept.
H-FICKEN: I did. They're the ones who told me that.
CP: Indeed. And you believed them?
H-FICKEN: Of course.
CP: As opposed to me. The pharmacist? The almost-most trusted professional in the country, standing in front of you, telling you I know how to do my job and what pieces of information I need and how the process works and this ain't my first rodeo?
FICKEN: Right.

CP: I fixed it.
FICKEN: You put it in THE System?
CP: No. Turns out we filled something for another family member at another store.
FICKEN: We said that.
CP: No. I asked if we had filled for HER before and you said "yes". Anyway, the new insurance is Medco. The ID#, phone#, group#, BIN#, PCN and well, everything else have no relation to this card you presented. They are as unrelated as African Swallows and German Shepherds.

Wednesday, February 18, 2015

Decide or Decide Not…Either Way

Quick! Make up your mind.

Really Unusual Situation Happening: I'm here to pick up a prescription. 
CP: Ok. 
RUSH: It's been here since 2/2. 
CP: Let me grab it. (Today is 2/12) 
RUSH: I got a bunch of phone calls about this. 
CP: What took you so long?
RUSH: Busy. They call me the working man. 
CP: Understood. Been working here too. Calling people to pick up their prescriptions. 
RUSH: What is it? 
CP: Zocor. Simvastatin. Your cholesterol medication. 
RUSH: Okay. I'll take it!
CP: That'll be $3.33. 
RUSH: <pays and grabs bag> Wait. 
CP: What? 
RUSH: I don't want it. 
CP: Why not? 
RUSH: I never had it before. 
CP: Then why did you get it? 
RUSH: I'm not sure really. 
CP: You went to the prescriber, right? 
RUSH: Yes. 
CP: With a complaint, right? 
RUSH: Yes. 
CP: Then how do you expect it to get better? 
RUSH: Not sure. 
CP: You went to the office. You were given a prescription. You brought it to us. You told us to fill it. You received 4 phone calls from us reminding you it was here. You came in to get it. You asked me what it was for. I told you. You took out your credit card. You paid for it. You pulled it off the counter and THEN you decided you didn't want it because "you'd never taken it before"? Did this really just happen? 
RUSH: Well…
CP: Look. You need to decide right now if you want this. If you choose not to decide, you still have made a choice. But I'm walking away and you're keeping this. Besides, how would you know you enjoyed ice cream if your parents hadn't given it to you? Or marijuana? Bet you never passed up a chance for a toke at a concert yet this, THIS is where you draw the line? 
RUSH: You're right. And oh, so wise. 

Tuesday, February 17, 2015

Out of Touch With Reality

There used to be a time, not so long ago, where life was normal. Where people had average expectations and lived average lives. There were always the outliers, but the majority of people tended to follow the same path. 
You would be born. You would go to school. You would move out of your parents' house. You would get your own place to live, your own insurance, your own job, your own responsibilities. The job of a parent is to prepare your children to become the next round of responsible adults set to inherit the planet and its issues. However, in this current era of self-entitlement, where you can be famous for being famous, people are used to having everything done for them. Battles are fought FOR them (helicopter parents, really?). 

I suppose it should come as no surprise that this was my Quote of The Week winner:

Gone Girl: This isn't fair!
CP: How's that? 
GG: "Under Obamacare they just kick you off your parents' insurance after a certain age. That's just wrong!" 
CP: Life sucks, huh? 
GG: It sure does. 
CP: I mean, you're only 28 years old, still living at home, with your boyfriend there, right?
GG: Yeah. 
CP: And mom and dad still cook for you and buy groceries?
GG: Yeah. 
CP: And I'm sure when you get home and whine to them about how unfair life is that I'll get a phone call scolding me for not caring about your plight. Mommy or Daddy will fight your battle while you snivel in the background that "the mean pharmacist said I didn't have insurance and now I can't play 'bump the uglies' with my boyfriend". 
GG: Well I never!
CP: I know. And that's your problem. All that reality TV you watch didn't prepare you for Reality Life.  Here's your dose of reality. 
GG: I'm calling my mom. 
CP: Her name wouldn't happen to be Lysa Arryn, would it?